16 Del. Admin. Code § 15000-15120
This section describes the eligibility requirements under the Prospective Group. Prospective Group is an extended eligibility period of up to four consecutive calendar months for a family who becomes ineligible due to an increased collection of spousal support.
An individual must meet the general eligibility requirements described in Section 14000.
An individual must have received Delaware Medicaid under the Parent/Caretaker Relative group in three of the six month immediately preceding the month of ineligibility under that section.
A parent or caretaker relative is considered to have received Medicaid in any month Medicaid was correctly provided. This does not include Medicaid provided:
| * | in error; |
| * | pending a hearing if the agency's action is upheld and the Medicaid provided is recoverable as an overpayment; or |
| * | for a month of ineligibility because of administrative notice requirements. |
The parent or caretaker relative must have lost eligibility wholly or partly as a result of new or increased spousal support collections. The collection of spousal support must cause or actively contribute to ineligibility. Regulations require that the collection of spousal support be paid directly to the IV-D agency - the Delaware Division of Child Support Enforcement.
The parent or caretaker relative must continue to have a dependent child as defined in Section 15100.1 living in the home.
When the only child no longer meets the age requirement, the parent or caretaker relative is no longer eligible for Prospective Group coverage. When one child turns age 18 or 19, but there is another child in the family, the child who turns age 18 or 19 is no longer considered a member of the Prospective Group family unit. The rest of the family remains eligible for Prospective Group coverage.
Prospective Group eligibility begins with the month of ineligibility under the Parent/Caretaker Relative Group due to new or increased spousal support collections. A family who is not timely in reporting the start of new or increased spousal support collections could have the extension period reduced. The family must be notified they are eligible for the Prospective Group and the reasons why Prospective Group coverage could be terminated.
Prospective is provided to all individuals who were included in the family at the time the family became ineligible. This includes a dependent child in the Children Group defined in Section 15300. In addition, family members who enter the household or family members who were absent but return may be found eligible. An individual who enters the family unit (including a child born to the family during the extended period) may be eligible for Prospective Group coverage if that individual would have been included in the parent or caretaker relative's family unit if the household were applying in the current month.
16 Del. Admin. Code § 15000-15120